title: The long-term effects of psychotherapy added to pharmacotherapy on morning to evening diurnal cortisol patterns in outpatients with major depression.
abstract: BACKGROUND
  Psychotherapy added to pharmacotherapy results in greater improvement in clinical outcomes than does pharmacotherapy alone. However, few studies examined how psychotherapy coupled with pharmacotherapy could produce a long-term protective effect by improving the psychobiological stress response.
  
  
  METHODS
  The researchers recruited 63 subjects with major depressive disorder (MDD) in an outpatient department of psychiatry at a general hospital. The randomly assigned subjects formed 2 groups: 29 in combined therapy (COMB) and 34 in monotherapy (MT). The COMB included 8 weekly body-mind-spirit group psychotherapy sessions added to pharmacotherapy. MT consisted of pharmacotherapy only. The outcome measures, collected at the subjects' homes, included the Beck Depression Inventory II (BDI-II), the State Trait Anxiety Inventory (STAI) and salivary cortisol on awakening, 45 min after awakening, and at 12.00, 17.00 and 21.00 h. Evaluation of outcome measures was at baseline condition, and at months 2 (end of additional psychotherapy), 5 and 8.
  
  
  RESULTS
  While the decreases in symptoms of depression were similar between COMB and MT (p > 0.05), the reductions in anxiety state were greater in COMB than in MT during the 8-month follow-up (p < 0.05). A steeper diurnal cortisol pattern more likely occurred in COMB than in MT in the 3 follow-up periods (p < 0.05, p <0.001 and p < 0.01).
  
  
  CONCLUSIONS
  The superior outcomes of group psychotherapy added to pharmacotherapy for MDD outpatients could relate to decreasing the anxiety state and to producing long-term impacts on positive stress endocrine outcomes seen as a steeper diurnal cortisol pattern.
authors.affiliation: Department of Nursing, College of Medicine, National Taiwan University, Taipei, Republic of China.
authors.forename: Fei-Hsiu
authors.initials: FH
authors.lastname: Hsiao
authors.forename: Guey-Mei
authors.initials: GM
authors.lastname: Jow
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Lai
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chen
authors.forename: Kuo-Chang
authors.initials: KC
authors.lastname: Wang
authors.forename: Siu-Man
authors.initials: SM
authors.lastname: Ng
authors.forename: Rainbow T H
authors.initials: RT
authors.lastname: Ho
authors.forename: Cecilia L W
authors.initials: CL
authors.lastname: Chan
authors.forename: Tsung-Tsair
authors.initials: TT
authors.lastname: Yang
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002940:Circadian Rhythm; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000378:metabolism* / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008297:Male; D026441:Mind-Body Therapies / Q000379:methods; D010045:Outpatients / Q000523:psychology* / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011615:Psychotherapy, Group / Q000379:methods*; D012463:Saliva / Q000378:metabolism; D016037:Single-Blind Method; D013995:Time; D016896:Treatment Outcome
chemical_list: D006854:Hydrocortisone